The formation of a Cardiovascular Imaging section within the Division of Cardiovascular Medicine recognizes the increasing number of imaging modalities, their complexity and their often complementary ability to detect cardiovascular pathology. The stated goal of Cardiovascular Imaging at Stony Brook is to match the appropriate imaging modality or modalities to an individual patient rather than the traditional approach of bouncing a patient from one disconnected imaging laboratory to the next in the hopes of making a diagnosis. In collaboration with our colleagues in the Department of Radiology we are establishing an Imaging Consultation Service where the most complex patients can be referred for a single evaluation in which multiple imagers contribute to the creation of tailored imaging approach.
The Echocardiography Laboratory at Stony Brook Medicine performs a full range of procedures, including transthoracic echocardiograms, transesophageal echocardiograms, treadmill stress tests and dobutamine stress tests. With a total of 10 state-of-the-art ultrasound systems, and a new treadmill and stress testing system, our laboratory performs approximately 10,000 procedures annually. The laboratory is fully digital and all studies are securely stored on a dedicated server to facilitate retrieval and interpretation of data for clinical and teaching purposes.
All cardiology fellows learn how to scan patients from our registered sonographers. The fellows are expected to preliminary read their own studies, and are encouraged to read as many studies as possible. Feed back and teaching is provided daily by our cardiologists who specialized in echocardiography.
The fellows rotating in the lab will get to learn the most innovative technologies available in echocardiography today, such as 3D echocardiography, tissue Doppler, strain and strain rate imaging, and will participate in the most cutting edge procedures, such as cardiac resynchronization therapy, pacemaker optimization and intracardiac echocardiography. As part of their training, the fellows will perform echocardiograms in the operating room, catheterization laboratory and electrophysiology laboratory and will guide innovative surgical and percutaneous procedures, such as investigational mitral valve repair, closure of intracardiac defects, and ablation of various arrhythmias.
Upon completion of cardiology fellowship, interested fellows should be able to achieve level II training in echocardiography and be prepared to pass the echo boards.
The laboratory is committed to performing research and is currently involved in various research studies, including evaluation of new technologies not yet available for clinical use. Fellows are encouraged to initiate research projects as well as participate in the on going ones.
The Nuclear Cardiology Service is a collaboration between the Cardiovascular Division and the Division of Nuclear Medicine of the Department of Radiology. The service is responsible for performing diagnostic exercise and pharmacologic stress testing in over 2,500 patients each year undergoing either myocardial perfusion imaging or radionuclide ventriculography. State-of-the-art multihead single-photon emission computed tomography (SPECT) equipment is available for all clinical studies. In addition, whole-body positron-emission tomographic instruments are available for diagnostic and research studies.
Clinical trainees rotate through the Nuclear Cardiology Service and are responsible for performing and interpreting stress tests. Trainees also provide medical clearance for patient studies, review tests with the attending cardiologist, and interpret results of imaging studies with faculty members with expertise in this field. Conferences and teaching sessions explore the physiologic and pathophysiologic response to exercise; techniques for assessment of myocardial perfusion, metabolism, and function; and the diagnostic and prognostic applications of stress testing and imaging studies.
Cardiovascular MR and CT
The Advanced Cardiac Imaging Program at Stony Brook has both 1.5 and 3T cardiac MR scanners and three 64-slice MDCT scanners. One of the three 64-slice MDCT is located within the Emergency Department and is active in performing cardiac CTA for the evaluation of low to intermediate risk patients with acute chest pain. In May 2009, a brand new and dedicated Advanced Cardiac Imaging training center will be opened at Stony Brook for physicians and technologists seeking basic and advanced training in cardiac MRI and CTA. The center is equipped with dedicated workstations and teaching materials for both cardiac CT and MR training. The training program will offer SCMR and SCCT level I, II, and III training and credentialling opportunities and CME credits for physicians and physicians-in-training as well as for CT and MR technologists on a regular basis. The Advanced Cardiac Imaging Program is currently collaborating with the Stony Brook's Center of Wireless and Information Technology (CEWIT) in the development of state-of-the-art technology for image compression, segmentation, and transfer. Others research projects include software development for cardiac MR quantitative analysis, computed-aided diagnosis for coronary CTA, and multi-center clinical trials on the assessement of cardiac viability and remodelling using cardiac MRI and the accuracy of coronary CTA in patients with stable chest pain.